Artificial intelligence (AI) refers to “the ability of a digital machine or computer to accomplish tasks that traditionally have required human intelligence.” These days, artificial intelligence is becoming popular in healthcare and more so in ophthalmology. It has shown promising results in diabetic retinopathy detection and referral. Recently, Indian data has depicted that the new algorithms can be generalized to the Indian population as well. An increased understanding of the tools is required especially by the practitioners and medical researchers so that they can contribute meaningfully to the development of the technology and not become mere data providers and data labelers. While AI is extensively being used by finance, marketing and travel industry, its application is more recent in medicine. The applications based on artificial intelligence have the potential to benefit all stakeholders in the healthcare industry.

Optimal visualization is one of the most challenging aspects of performing vitreoretinal surgery. In situations where conventional microscopic techniques provide poor posterior visualization, the adjunctive skill set of endoscopic visualization may be needed. This allows for by-passing the opaque anterior segment media and getting access to the posterior segment pathology. Endoscopic vitrectomy is a useful and unique adjunct to microincision vitreoretinal surgery. The optical set-up of endoscopy allows for clinical approaches that are impossible with regular microscope viewing systems. These include the ability to observe across optically significant anterior segment opacities and directly visualize the posterior segment of the eye. It also allows for visualizing the difficult-to-access retroirideal, retrolental, and anterior retinal structures. Surgical access to anatomic spaces like the pars plana, pars plicata, ciliary sulcus, ciliary body, and peripheral lens is tedious. This is made simpler by endoscopy. In this review, we summarize and review the usage of the intraocular endoscope as a diagnostic and therapeutic armamentarium across a wide spectrum of ocular pathologies.

Optic neuritis (ON) refers to conditions that involve inflammation of the optic nerve. Various autoantibodies have been found, which are associated with central nervous system inflammatory disorders and have provided much information about the immune targets and mechanisms that impact the prognosis, treatment, and recurrence of atypical ON. Therefore, neurologists and ophthalmologists together should work to find out clinical, laboratory, and imaging findings that may provide important clues to the etiology of atypical ON and its management. Various biomarkers have been identified to confirm and distinguish atypical optic neuritis from others. The purpose of this review is to present the current scenario of atypical ON and its clinical management.

Authorship is the currency of an academic career. Scientific publications have significant academic and financial implications. Several standard authorship guidelines exist, and the International Committee of Medical Journal Editors (ICMJE) is the most popular amongst them. There are increasing concerns about the ethics of publications with the rise of inappropriate authorship. The most important reason appears to be a lack of knowledge and awareness of the authorship guidelines and what actions constitute unethical behaviors. There is a need to incorporate standard guidelines in medical curricula and conduct structured training and education programs for researchers across the board. The current perspective describes the significant concepts of appropriate and inappropriate authorship, and the possible measures being formulated to shape the future of authorship.

Purpose: Fifteen years after the publication of the Ophthalmic Clinical Evaluation Exercise (OCEX), it was deemed necessary to review and revise it, and to validate it for an international audience of ophthalmologists. This study to revise the OCEX and validate it for international use. Methods: The OCEX rubric was changed to a modified Dreyfus scale; a behavioral descriptor was created for each category. An international panel of ophthalmic educators reviewed the international applicability and appropriateness of the tool. Results: A tool for assessing and giving feedback on four aspects of clinical competence during the ophthalmic consultation (interview skills, examination, interpersonal and communication skills, and case presentation) was revised. The original scoring tool was improved to a new behavioral one, and relevant comments and suggestions from international reviewers were incorporated. The new tool has face and content validity for an international audience. Conclusion: The OCEX is the only tool for workplace assessment and feedback specifically for ophthalmology residents and the ophthalmic consultation. This improved and simplified version will facilitate its use and implementation to diverse programs around the world.

Purpose: Assessing visual acuity (VA) is the cornerstone of an ophthalmic workup and needs VA charts in a four or six meters space. The objective of this study was to compare the performance of distant VA (DVA) on one meter mini-logMAR (MLM) with a standard six meter logMAR (SLM) chart. Methods: We developed a MLM chart to be used at 1 m with +1.0 D spectacles, by reducing the SLM chart designed for 6 meters, to 1/6^th its size, using AutoCAD version 2014. On an initial cohort, we obtained DVA on the two charts by optometrist trainees, masked to the outcomes on the different tests. We performed regression and checked agreement between the two measurements. Subsequently, on a new cohort, we validated the performance of the MLM. Results: Of the 56 initial subjects, mean DVA with SLM was 0.44 ± 0.13 and with MLM was 0.45 ± 0.13; mean difference of -0.01 ± 0.02, 95%CI: 0.007 to 0.018; P < 0.0001 on paired t-test. There was a significant correlation: r = 0.99; r² = 0.98, P < 0.0001. On an average, DVA with MLM was less than a letter worse than with SLM. The regression formula obtained: SLM DVA = -0.1312 + 1.0014 x (MLM DVA). The validation study revealed no significant difference (P = 0.29) between the predicted standard DVA calculated by the regression formula and the actual standard. Conclusion: We suggest that we can deduce distance logMAR VA from a mini-logMAR chart as devised and used by us. This will take less space, be portable and allow congenial interaction with patients.

Purpose: This study aimed to reveal the cause of meibomian gland disease and meibomian gland loss in patients with Sjögren's syndrome (SS) as the leading factor for dry eyes. Methods: The study included a total of 30 patients with SS and dry eye symptoms and a control group of 50 age- and gender-matched healthy subjects. The dryness parameters of all the participants were evaluated. At first, meibography was performed to measure meibomian gland loss using noninvasive methods. Later, meibomian gland expression and secretion quality were evaluated using silt-lamp biomicroscopy. Correlations between the measurements were analyzed statistically. Results: In patients with SS, MG loss was significantly greater than in the control group (19.7 ± 71%, 12.7 ± 9.6%, P < 0.001). All dry eye parameters (tear film breakup time, Schirmer's test score, OSDI, stain score, dry eye disease) were statistically significant in the SS group. There was an extremely negative correlation between upper MB loss and BUT (P = 0.08, r: 0.781). There was an extremely positive correlation between upper MB loss and staining (P = 0.015, r: 0.739). An extremely negative correlation was determined between sub-MB loss and BUT (P = 0.18, r:-0.781), and a moderately positive significant correlation was found between sub-MB loss and staining (P = 0.031, r: 0.659). Conclusion: The results of this study demonstrated that patients with SS were at a higher risk of being exposed to meibomian gland loss, which directly leads to the severe dry eye symptoms associated with SS.

Purpose: To evaluate the outcomes of early amniotic membrane transplant (AMT) in acute ocular surface burns using Dua's classification. Methods: In this retrospective analysis conducted at a tertiary eye care center in Western India. We included 27 eyes of 24 patients from May 2014 to May 2019 who underwent AMT within 2 weeks post insult along with medical treatment for acute ocular surface burns using Dua's classification for grading on presentation. Post-operative assessment for ocular surface epithelization, corneal vascularization, symblepharon formation, and visual outcome at the time of complete epithelization was done. Results: Eight, seven, three, and nine eyes with grade III, IV, V, and VI, respectively, were included in the study. The mean duration of the presentation was 5.5 ± 3.6 days, with the mean follow-up of 4.83 ± 2.2 months. Alkali burn (62.96%, 17/27 eyes) was the commonest. The mean epithelization time was 5.80 ± 2.92 weeks. Corneal vascularization for >6 clock hours was seen in 52.38% (11/21 eyes with vascularization). Symblepharon was seen in 55.55% (15/27 eyes). Vision improvement and corneal vascularization to a lesser extent (<6 clock hours) was observed in Group A (grades III and IV) as compared to group B (grades V and VI) and found to be significant (P-value = 0.031, P value = 0.007, respectively). Conclusion: Amniotic membrane grafting is a useful aid in moderate grades of acute ocular surface burns with an important adjunct role in severe cases.

Purpose: To compare horizontal and vertical split conjunctival autograft technique in the management of double head pterygium. Methods: Retrospective analysis of 96 and 99 eyes with double head pterygia that underwent horizontal (Group 1) and vertical (Group 2) split conjunctival autografting, respectively. Comparison of recurrence rates and other complications was done. Results: Recurrence was seen in 5.2% and 4% of the eyes in Groups 1 and 2, respectively (P > 0.05). Other complications like subconjunctival hemorrhage, graft edema, graft retraction, granuloma, and graft loss were also comparable among the two groups. Conclusion: Both the techniques provide good results with comparable efficacy in terms of rates of recurrence and complication profiles.

Purpose: To describe a new technique of intracorneal scleral patch (ICSP) supported cyanoacrylate tissue adhesive (CTA) application in corneal perforations, greater than 3.0 mm secondary to rheumatoid arthritis (RA). Methods: This Prospective, non-randomized, non-comparative, interventional series included 14 eyes (14 patients). All patients had corneal perforations sized 3.5 to 4.5 mm due to RA, which were treated with ICSP supported CTA application. A partial thickness scleral patch 1.0 mm larger than diameter of corneal perforation was prepared. A lamellar corneal pocket 0.5 mm all around the corneal perforation was created. The partial thickness scleral patch was placed in the corneal perforation site and the edge was fitted into the lamellar intracorneal pocket. A minimum quantity of CTA was applied on the scleral patch to seal the perforation. Results: The corneal perforations healed in 14 eyes (100%) in a mean 7.71 ± 1.14 (range, 6–9) weeks. One eye (7.14%) had inadvertent extrusion of ICSP due to premature removal of CTA but, Seidel's test was negative, and the corneal epithelial defect healed with BCL alone. One eye each (7.14%) developed steroid induced cataract and glaucoma. None of eyes developed infective keratitis, re-opening of corneal perforation (necessitating repeat procedure) or enlargement of corneal perforation requiring penetrating keratoplasty (PKP). Conclusion: ICSP supported CTA application is a successful alternative option to emergency PKP in treating corneal perforations sized 3.5 to 4.5 mm with associated RA.

Purpose: Therapeutic contact lenses (TCL) are known to help in epithelial healing and decreasing pain after various corneal surgeries. However, literature lacks any data describing their use following Descemet's stripping automated endothelial keratoplasty (DSAEK) where intraoperative epithelial debridement is commonly performed. Here we study the efficacy and safety of TCL in patients undergoing DSAEK. Methods: In this prospective, randomized, controlled clinical trial. 40 eyes of 40 patients of pseudophakic bullous keratopathy undergoing DSAEK were enrolled and randomized into two groups, control (no TCL) and test (TCL). Primary outcome was time taken for epithelial healing and secondary outcomes were postoperative pain score, graft attachment, best spectacle-corrected visual acuity, and endothelial cell loss at 3 months. Results: Average time taken for epithelial healing was 3.35 ± 0.49 days in the test group and 4.95 ± 1.05 days in the control group (P < 0.001). Average pain scores in first operative week were significantly lower in the test group as compared to control (P < 0.001). Graft detachment occurred in eight patients in control group and two in test group (P = 0.03). Both rebubbling rates and average endothelial cell loss at 3 months were higher in the control group with P = 0.07 and 0.06 respectively. No contact lens-related adverse effects were noted during the study period. Conclusion: Use of TCL in DSAEK leads to faster epithelial healing and lesser postoperative pain. In addition, it may also contribute to lower rebubbling rates and endothelial cell loss.

Purpose: Oral Triclofos is widely used as a sedative agent in children. However, the role of Triclofos as a sedative agent in children undergoing ophthalmological procedures has not been adequately studied. The aim of this study was to determine the safety and efficacy of oral Triclofos in children suffering from pediatric glaucoma who were undergoing ocular examination. Methods: 80 children aged less than 5 years were assessed for eligibility for the trial after taking hospital ethical committee approval. The children were administered 80 mg/kg of oral Triclofos and Ramsay sedation score was measured every 5 min starting from 20 min after administration of the drug. If the child was not adequately sedated after 30 min, additional dose of 05 mg/kg was administered every 5 min till 60 min of drug administration. The procedure was considered a failure and general anesthesia (GA) administered if Ramsay sedation score was ≤4 after 60 min of initial drug administration. Heart rate and arterial oxygen saturation were measured throughout the period of sedation. The duration of sedation and incidence of side effects was also noted. Results: A total of 73 patients underwent the study. The mean age of children was 23.4 months (SD – 14.72) and mean weight was 12 kg (SD – 3.84). The mean dose of Pedicloryl (Triclofos) used was 83.8 mg/kg and the median duration of onset was 25 min. 64 children completed examination successfully, 2 children had to be administered GA during the procedure. There were no major side effects. Conclusion: Administration of oral Triclofos in a dose of 80 mg/kg body weight was safe and effective in children less than 5 years of age undergoing ocular examination.

Purpose: The aim of this study was to determine the correlation between the perimetric outcomes using a free application program of the iPad, 'Visual Fields Easy' (VFE), and Humphrey Visual Field Analyzer (HVFA), in normal as well as eyes with glaucomatous damage of varying severity. Methods: In this prospective, cross-sectional, observational pilot investigation, visual field testing was carried out in 210 eyes of 210 patients (60 Normal, 150 Glaucoma), using suprathreshold VFE application (Version 8) on the iPad and Standard White-on-White using HVFA. Severity of glaucoma was categorized using Hodapp-Anderson-Parrish criteria for visual field defects. The results of the VFE program were compared to the 24-2 SITA FAST HVFA. Results: Data of 210 patients, 100 (47.6%) females, and 110 (52.4%) males, age ranging from 42 to 78 years, Mean 56.64 ± 10.67 years, was analyzed. The Spearman correlation coefficient showed a significant inverse relationship between missed points on the VFE app with MD (S = –0.783) and a parabolic relationship with PSD (S = 0.646) values obtained with the HVFA. As regards missed points, for mild glaucoma, missed points were 37.5, sensitivity was 77.8% and specificity was 52.6%; for moderate glaucoma, missed points were 33.5, sensitivity was 90% and specificity was 48% while for severe glaucoma, missed points were 23, sensitivity was 97% and specificity was 70%. AROC for eyes with mild glaucoma versus normal was 0.419 (95% CI: 0.343-0.495), moderate glaucoma versus normal was 0.705 (95% CI: 0.630-0.780) and severe glaucoma versus normal was 0.857 (95% CI: 0.806-0.908). Conclusion: Suprathreshold perimetry using VFE is not suitable as a rapid screening tool for mass screening of glaucoma. VFE cannot be used as a substitute for HVFA in clinic because of its inability to detect early or moderate glaucoma.

Purpose: To evaluate the effectiveness of repeat trabeculectomy with Mitomycin C (MMC) in isolation or combined with phacoemulsification, and to identify risk factors for failure over 1 year. Methods: Retrospective review of 113 eyes of 113 patients (49 primary open angle, 27 primary angle closure, 37 secondary glaucoma) who underwent repeat trabeculectomy with MMC (isolated trabeculectomy 75 and phacotrabeculectomy 38). The primary outcome measure was intraocular pressure (IOP) at 1 year follow-up. Three IOP criteria were chosen to measure success A) IOP ≤21 mmHg and ≥20% reduction from baseline. B) IOP ≤17 mmHg and ≥20% reduction from baseline. C) IOP ≤14 mmHg. Results: Mean IOP decreased from 24.5 ± 8.8 mmHg to 16.4 ± 7.6 mmHg 1 year after repeat trabeculectomy. The mean number of medications reduced from 2.9 ± 1.0 to 0.6 ± 1.0. Complete success with trabeculectomy versus phacotrabeculectomy for criterion A was 60% vs 55.3%, criterion B 54.7% vs 50.0% and criterion C 40.0% vs 28.9%. IOP ≤14 mmHg was more likely with trabeculectomy than phacotrabeculectomy (P = 0.047). On regression analysis, duration between surgeries ≤4 years (P = 0.018) and secondary glaucoma (P = 0.046) were identified as risk factors for surgical failure with criterion A. Younger age (P = 0.042), fornix based flap (P = 0.058), and phacotrabeculectomy (P = 0.042) for criterion C. Conclusion: Repeat trabeculectomy with MMC is successful at lowering IOP and decreasing number of antiglaucoma medications. Low IOP levels are less likely with phacotrabeculectomy.

Purpose: To compare the standard and “innovative wide-field” optical coherence tomography images in assessment of vitreoretinal interface in proliferative diabetic retinopathy. Methods: Fifty consecutive eyes of 25 patients with proliferative diabetic retinopathy underwent 12 × 12 mm radial swept source-optical coherence tomography (OCT) imaging using standard technique and innovative wide-field (+90D) technique. The image expansion ratio was calculated using Image J software. Results: Out of the 50 eyes, only in four eyes with +90 D were minimally misaligned or were having quality less than grade 2 as compared to standard OCT. The mean age group was 51 ± 4.5 years. The expansion ratio (scan length) increased by a factor of 1.65 ± 0.67 when obtained using +90 D technique. Conclusion: Innovative wide-field technique provides us with the widest of available OCT scans with the presently available machine and the software.

Purpose: To investigate the structural and functional changes of the retina and optic nerve in amblyopia. Methods: Eighteen patients with unilateral anisometropic amblyopia and 27 age-matched healthy controls were involved in this study. All patients underwent optical coherence tomography angiography (OCTA), pattern visual evoked potential (pVEP), and flash electroretinogram (fERG). Results: There was no statistically significant difference in terms of the foveal avascular zone (FAZ), perifoveal superficial density, whole superficial density, parafoveal deep density, perifoveal deep density among the eyes (P > 0 0.05). Significant differences were found only in superficial capillary plexus (SCP) vessel density in whole (P = 0.029) and parafoveal (P = 0.008) image. In electrophysiological tests, while VEP latencies of the amblyopic eyes increased compared to nonamblyopic eyes and controls (P = 0.027), VEP amplitudes decreased in amblyopic and nonamblyopic eyes compared to controls (P = 0.01), amplitudes of the rod (P = 0.027) and cones (P < 0.001) also decreased in amblyopic eyes compared to nonamblyopic and healthy eyes. When we assessed the correlation between the parameters of OCTA and electrophysiological test, only a significant correlation was found between parafoveal SCP vessel density and VEP amplitudes (r = 0.341). Conclusion: We found a significant decrease only in SCP vessel density of the OCTA parameters in amblyopic eyes compared to healthy eyes. We detected a significant relationship between parafoveal SCP vessel density and VEP parameters, which might be associated with the underlying pathophysiology of the amblyopia.

Purpose: To study the effectiveness of part-time occlusion (PTO) in different types of amblyopia in Indian population. Methods: Prospective case series of consecutive cases of amblyopia from a tertiary care center were subjected to PTO of the better eye and monitored periodically for 6 months. Those who failed to improve by 6 months were shifted to full-time occlusion of the better eye and followed for a further 3 months. Results: 175 eyes of 175 patients with amblyopia underwent PTO for 6 months. The mean age of the patients was 10.47 ± 4.69 years (range: 3–26 years). Major subgroups included 94 eyes with strabismic amblyopia and 70 with anisometropic amblyopia. Overall, 168 (96%) children benefited from PTO (improvement being defined as a gain of at least one line of Snellen's visual acuity). The improvement rates for strabismic amblyopes (97.9%) was significantly more than anisometropia (94.3%); P = 0.027. Of the seven patients not responding to PTO, six did not benefit even after full-time patching. Conclusion: PTO is a viable and effective modality of management of amblyopia in Indian patients. Strabismic amblyopia was the commonest and responded best to the occlusion therapy in our cohort.

Purpose: Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT). Methods: This study was conducted as a part of the ongoing study titled “Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN).” Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment. Results: A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%–97.7%) and the specificity was 93.4% (95% CI: 91.6%–94.9%). Positive predictive value was 41.9% (95% CI: 32.3%–51.9%) and negative predictive value was 99.5% (95% CI: 98.8%–99.9%) with a moderate agreement (0.54; 95% CI 0.49–0.64) between VT screening and screening with SVS. Conclusion: The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.

Purpose: To measure sensitivity and specificity of vision screeners in identifying children with visual impairment and positive signs and symptoms and assess association of effectiveness with individual characteristics of screeners and type of schools screened. Methods: A total of 1096 children from age 5 to 15 years of age were screened. A total of 396 children were screened from a municipal school, 200 children from a government-aided school, and 500 children from a private school were screened. Four persons with basic 12th standard science qualification willing to be a part of school eye health program were selected who carried out screening in school children after receiving appropriate training. Results: The two vision screeners who had a background of conducting community eye health programs and worked in eye hospital had 100% sensitivity and specificity for presenting visual acuity, squint detection, and blurring. The screening by these screeners was done in private and semi-private schools, respectively. The other two screeners with no such background conducting screening in government schools had 60% and 75% sensitivity in detecting presenting visual acuity, respectively. Conclusion: People with a background of organizing community eye health programs and those working in eye hospitals are the best candidates for being trained as new cadre of vision screeners with best results being obtained in private and government-aided schools.

Purpose: To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to learn print. Methods: A prospective study was conducted among children from two local schools for the blind. Best-corrected visual acuity (BCVA) was done using the Snellen chart. Children with BCVA of counting finger (CF) 1/2 meter or more in the better eye underwent low vision assessment. Distant vision was assessed using the Feinbloom chart and near vision was assessed using the Lea symbol chart. Low vision devices (LVD) were prescribed as required. Results: Among 185 children enrolled, 31 children had BCVA of >CF ½ meter. Using a telescope, distant vision was better than 3/36 in 48.4%, 3/36–3/12 in 16.2%, and 3/9.5 to 3/3 in 35.4%. Among 23 children who read 1M at <10 cm, 22.6% could read 0.6–0.8M, and 25.8% could read 1M using LVD. Conclusion: Regular screening of children in schools for the blind could identify children who might benefit from LVD. A review of protocols for the entry of children in schools for the blind by screening these children by a specialist team prior to admission should be made mandatory.

Purpose: Authors analyzed long-term surgical outcomes of infantile esotropia and the occurrence of associated strabismus, inferior oblique overaction (IOOA), and dissociated vertical deviation (DVD). Clinical factors related to the occurrence of IOOA and DVD in patients with infantile esotropia were also evaluated. Methods: Medical records of patients with infantile esotropia, who underwent surgery between 1995 and 2008, were reviewed retrospectively. Included patients were followed for at least 10 years. The incidence and age at development of IOOA and DVD were analyzed. To evaluate predisposing factors for developing IOOA or DVD, patients were divided into two groups: those with infantile esotropia only (group A) and those who developed IOOA or DVD (group B). Results: A total of 122 patients were enrolled and mean follow-up period was 16.0 years (range: 10–32 years). The mean number of surgeries was 1.7 (range: 1–5), and 64 (52.5%) patients achieved optimal horizontal alignment (esotropia <10 prism diopters [PD] and orthotropia). Fifty (41.0%) patients developed IOOA at a median age of 3 years (range: 1–21 years); 54 (44.3%) developed DVD at a median age of 5 years (range: 1–25 years). Patients in group B underwent more horizontal surgeries than those in group A (P = 0.028), and favorable surgical outcomes between the two groups were not different at final visit. There were no other significant differences in clinical factors between the two groups. Conclusion: Approximately, 52.5% of patients achieved favorable surgical outcomes through 1.7 surgeries during the 10-year follow-up period. DVD tended to develop at a later age than IOOA, and in some cases, up to 20 years after diagnosis of infantile esotropia. To achieve favorable horizontal alignment at final visit, patients with associated vertical strabismus underwent more horizontal muscle surgeries than patients with infantile esotropia only. The presence of IOOA/DVD may affect horizontal alignment outcomes.

Purpose: To provide real-world data on the world-wide-web for patient and doctor awareness. Methods: From December 2017 to January 2020, consecutive patients with choroidal melanoma (CM), iris ciliary body melanoma (ICM), and ocular surface squamous carcinoma (OSSC) had specific outcomes recorded at each return visit. Each result was anonymized, entered in an online portal, and sent to a unique software program where it was used to create real-world data of number of patients, mean vision, local tumor control, eye salvage, systemic metastases, and length of follow-up for our eye cancer center. Results: A HIPAA compliant, internet-based software program was developed and linked to public access web page to collect and analyze near-real-time data pertaining to the treatment, vision, life, and follow-up time of patients. During this period, CM radiation plaque tumor control was 99.7%, median vision 20/25 (mean 20/50) and eye salvage 95.8%. ICM tumor control was 99.1% and the median vision 20/20 (mean 20/20). OSSC tumor control was 100% and the most common vision was 20/20 (mean 20/25). Rates of primary enucleation as treatment were 4.2% for CM, 2.8% for ICM, and 0% for OSSC. All patient results were updated by the ophthalmic oncology fellow at each patient visit as to reflect near-real-time outcomes at our center. Conclusion: Prospective data collection of returning patients was found to be a simple method to reflect patient care outcomes. This method of reporting doctor outcomes offers a measure of transparency for patients and an opportunity to compare results with other clinical practices.

Purpose: The aim of this study was to determine prevalence, symptoms frequency and associated risk factors of digital eye strain (DES) among children attending online classes during COVID-19 pandemic. Methods: The online electronic survey form was prepared on the Google app. Children/parents were asked to indicate the total duration of digital device use before and during COVID era. The symptoms of DES, its severity and frequency were recorded & measured with the Computer Vision Syndrome Questionnaire. Results: Two hundred and sixty one parents responded to the questionnaire, of these 217 were complete. Mean age of children was 13 ± 2.45 years. Mean duration of digital device used during COVID era was 3.9 ± 1.9 h which is more than pre COVID era (1.9 ± 1.1 h, P = <0.0001). 36.9% (n = 80) were using digital devices >5 h in COVID era as compared to 1.8% (n = 4) before COVID era. The most common digital device used were smartphones (n = 134, 61.7%). One hundred and eight children (49.8%) were attending online classes for >2 h per day. Prevalence of DES in our cohort is 50.23% (109/217). Of these 26.3% were mild, 12.9% moderate and 11.1% of severe grade. Most common symptoms were itching and headache (n = 117, 53.9%). Multivariate analysis revealed age >14 years (P = 0.04), male gender (P = 0.0004), smartphone use (P = 0.003), use of device >5 h (P = 0.0007) and mobile games >1 h/day (P = 0.0001) as independent risk factors for DES in children. Conclusion: There is an increased prevalence of DES among children in COVID era. Parents should be considerate about duration, type and distance of digital device use to avoid DES symptoms in children.

Purpose: To analyze the impact of ophthalmic webinars on the resident's learning experience during the COVID-19 pandemic (CP). Methods: This cross-sectional nationwide study was carried out for 1 month during CP and included a total of 382 ophthalmic residents. A questionnaire was sent through various social media platforms. Results: Residents expressed a decline in their clinical exposure (74%; 220), thesis work (58%; 218), and acquisition of the knowledge and skills (42.5%; 161) during CP. Benefits of webinars as perceived by the residents included gain in additional knowledge (77%; 286), feedback on queries (56%; 209), access to multiple speakers (50%; 191), and topics (30%; 110). Nearly 75% (291) of residents endorsed webinars as good to the very good academic tool, and 54% (202) preferred to continue attending webinars in the post-CP phase. However, connectivity/download/data issues (54%; 200) followed by loss of personal touch (53%; 188), lengthy or irrelevant topic (37%; 134), and poor transmission quality (33%; 121) were major deterrents against the webinar. Conclusion: The current study generated overall mixed responses from the ophthalmic postgraduate residents in favor of webinars. In the present format, webinars bear enormous potentials to supplement the traditional learning tools by providing uninterrupted learning experiences. However, they are still limited by their pedagogical and technical issues.

We describe a simple, endoilluminator-assisted technique, which enables an easy identification of the descemet membrane endothelial keratoplasty graft orientation, as well as provides its good visualization in the anterior chamber, during all the steps of surgery in the wet lab.

Fishing is a worldwide pastime enjoyed by millions of people. Ocular fishing injuries though uncommon may cause potentially devastating ocular trauma. We report a rare case of penetrating injury of the cornea by a barbed fish hook and its successful surgical management by “cut-it out technique”. We are discussing the various techniques available for removal of fish hooks. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the appropriate method of extraction.